Fri May 17 2024

91 articles - From Friday May 10 2024 to Friday May 17 2024

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Guidelines

Guidelines and related publications, position statements, white papers, technical reviews, consensus statements, etc…

Clin Gastroenterol Hepatol

AGA Clinical Practice Update on Management of Inflammatory Bowel Disease in Patients with Malignancy: Commentary.

Methods This CPU was commissioned and approved by the AGA Institute CPU committee and the AGA Governing Board to provide timely guidance on a topic of high clinical importance to the AGA membership and underwent internal peer review by the CPU committee and external peer review through standard procedures of Clinical Gastroenterology and Hepatology. This communication incorporates important and recently published studies in the field, and it reflects the experiences of the authors who are experts in the diagnosis and management of IBD.

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Meta-analysis

meta-analyses and systematic reviews

Aliment Pharmacol Ther

Meta-analysis: Intestinal ultrasound to evaluate colonic contents and constipation.

US is an appealing imaging modality to assess luminal contents and constipation. Further well-designed studies are required to validate US metrics that accurately identify constipation.

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Am J Gastroenterol

Machine Learning Models for Pancreatic Cancer Risk Prediction Using Electronic Health Record Data - A Systematic Review and Assessment.

AI/ML models for PC risk prediction using known risk factors perform reasonably well and may have near-term applications in identifying cohorts for targeted PC screening if validated in real-world data sets. The combined use of structured and unstructured EHR data using emerging language models while incorporating explainable-AI techniques has the potential to identify novel PC risk factors and this approach merits further study.

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Clin Gastroenterol Hepatol

Definitions, etiologies and outcomes of acute on chronic liver failure: A systematic review and meta-analysis.

Heterogeneity in the definition of ACLF proposed by different expert societies and regional preferences in its use result in differences in clinical phenotype and outcomes. A uniform definition would enhance the comparability and interpretation of global data.

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Original articles

RCT, clinical trials, retrospective studies, etc…

Aliment Pharmacol Ther

Enteral nutrition compared with corticosteroids in children with Crohn's disease: A long-term nationwide study from the epi-IIRN.

EEN in paediatric CD is associated with lower long-term risks of corticosteroid dependency and hospitalisation than corticosteroids. These results may lend support to favouring nutritional therapy in paediatric CD.

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Am J Gastroenterol

Comparison of effective imaging modalities for detecting gastric neoplasms: A randomized three-arm phase II trial.

Compared to TXI and WLI, 3G-NBI is a more promising modality for GN detection.

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The natural history of eosinophilic gastrointestinal diseases is influenced by age of onset and location of involvement.

EGIDs with and without esophageal involvement display many similarities, although patients with esophageal involvement more frequently had dysphagia, progressive disease courses, and required more chronic therapy. Location of involvement and age at onset impacted the natural history with higher proportions of relapsing or progressive disease seen in adults and patients with small bowel or multiorgan involvement, while a continuous disease course was more common in children and patients with gastric-only involvement.

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Clin Gastroenterol Hepatol

All FODMAPs aren't created equal: Results of a randomized reintroduction trial in patients with irritable bowel syndrome.

Our results suggest that the reintroduction of select FODMAPs may be responsible for symptom generation in IBS patients who have responded to a low FODMAP diet, and provide a strong rationale for performing a future trial comparing the treatment effects of a limited low-FODMAP diet and a standard low-FODMAP diet.

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BENEFIT AND HARM OF ASPIRIN ON MORTALITY FROM GASTROINTESTINAL CANCERS VERSUS BLEEDING IN HELICOBACTER PYLORI-ERADICATED PATIENTS.

GI-cancer mortality benefit from aspirin outweighs bleeding-related mortality in HP-eradicated subjects, which is further enhanced by PPI use.

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Breastfeeding duration is not associated with offspring inflammatory bowel disease risk in three population-based birth cohorts.

In prospectively collected data from three population-based birth cohorts, the duration of exclusive or any breastfeeding was not associated with offspring IBD risk.

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Characterization of Biologic Discontinuation Among Pediatric Patients with Crohn's Disease.

Concomitant immunomodulator use and proactive TDM decreased risk of biologic discontinuation. Strategies are needed to preserve biologic efficacy and prevent biologic discontinuation.

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ChatGPT4 outperforms endoscopists for determination of post-colonoscopy re-screening and surveillance recommendations.

Initial real-world results suggest that ChatGPT4 can accurately define routine colonoscopy screening intervals based on verbatim input of clinical data. LLM have potential for clinical applications, but further training is needed for broad use.

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EFFICACY AND SAFETY OF USTEKINUMAB FOR CHRONIC POUCHITIS: A PROSPECTIVE OPEN-LABEL MULTICENTER STUDY.

Ustekinumab was efficacious in half of the patients suffering from chronic pouchitis. Ustekinumab should therefore be positioned in the treatment algorithm of chronic pouchitis. (ClinicalTrials.gov Number NCT04089345).

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Early liver transplant for alcohol-associated liver disease has excellent survival but higher rates of harmful alcohol use.

Patients who undergo ELT for ALD have similar or better survival than other diagnoses in the first 10-years after LT despite a higher incidence of post-LT alcohol use.

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Early-Onset Colorectal Cancer Patients Do Not Require Shorter Intervals for Post-Surgical Surveillance Colonoscopy.

EO-CRC patients do not have an increased risk of advanced neoplasia compared to AO-CRC patients and therefore do not require more frequent colonoscopy surveillance than current guidelines recommend.

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Effects of Thiopurine Withdrawal on Vedolizumab-Treated Patients With Ulcerative Colitis: a Randomized Controlled Trial.

Thiopurine withdrawal did not affect vedolizumab trough concentrations. However, it may increase fecal calprotectin, histologic and histo-endoscopic activity. Histological activity and prior anti-TNF exposure may predict disease relapse upon thiopurine withdrawal for patients using vedolizumab for UC; Australian and New Zealand Trial Registry, number ACTRN12618000812291.

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Epidemiology and Risk Factors of Eosinophilic Esophagitis in Japan: A Population-Based Study.

Nevertheless, EoE remains less common in Japan compared to the United States and Western Europe. Factors contributing to the epidemiology of EoE on a global basis may improve our understanding of the contribution of genetic and environmental risk factors.

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High prevalence and clinical relevance of intrapulmonary vascular dilatations in patients undergoing TIPS implantation.

Screening for IPVD before TIPS implantation could help to further identify patients at higher risk of cardiac and hepatic decompensation.

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Liver fibrosis assessed via non-invasive tests is associated with incident heart failure in a general population cohort.

In the general population, serum markers of liver fibrosis are associated with increased hospitalization/death from heart failure. Genetic polymorphisms associated with liver fibrosis were not positively associated with elevated heart failure risk.

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Long-term outcome of risankizumab in Crohn's disease: a real-world GETAID study.

This is the first real-life study to report long-term outcomes in patients with refractory CD treated with risankizumab. Half of the patients achieved steroid-free clinical remission after one year, and the safety profile was consistent with the literature.

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Ozanimod in Patients With Moderate to Severe Ulcerative Colitis Naive to Advanced Therapies.

Ozanimod is an effective, durable, and well-tolerated oral therapy for AT-naive ulcerative colitis patients.

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PNPLA3, obesity and heavy alcohol use in cirrhosis patients may exert a synergistic increase hepatocellular carcinoma risk.

The PNPLA3 variant may help refine risk stratification for HCC in patients with cirrhosis with heavy alcohol consumption or obesity who may need specific preventive measures.

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Safety and Efficacy of Novel Incretin Co-agonist Cotadutide in Biopsy-proven Non-cirrhotic MASH with Fibrosis.

PROXYMO provides preliminary evidence for the safety and efficacy of GLP-1/GCG receptor co-agonism in biopsy-proven non-cirrhotic MASH with fibrosis, supporting further evaluation of this mechanism in MASH.

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Updated Reference Intervals for Alanine Aminotransferase in a Metabolically and Histologically Normal Population.

Our study provided the newly established reference intervals for ALT levels in a metabolically and histologically verified Asian population. The proposed URL for ALT are 34 U/L and 22 U/L for males and females, respectively.

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VONOPRAZAN IS EFFICACIOUS FOR TREATMENT OF HEARTBURN IN NON-EROSIVE REFLUX DISEASE: A RANDOMIZED TRIAL.

Vonoprazan reduced heartburn symptoms in subjects diagnosed with NERD, with the benefit appearing to begin as early as the first day of therapy. Treatment effect persisted after the initial 4-week placebo-controlled period throughout the 20-week extension period. The two vonoprazan doses (10 and 20mg) were similar in efficacy. (ClinicalTrials.gov NCT05195528).

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Endoscopy

A computer-aided detection system in the everyday setting of diagnostic, screening and surveillance colonoscopy: an international, randomized trial.

In this study conducted by experienced endoscopists, CADe did not result in a statistically significant increase in ADR. However, the ADR of our control group substantially surpassed our sample size assumptions, increasing the risk of an underpowered trial. (Trialsearch.who.int NL9135).

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Impact of linked color imaging on the proximal adenoma miss rate: a multicenter tandem randomized controlled trial. The COCORICO trial.

In contrast to previous data, this study does not support the benefit of LCI regarding pAMR in routine colonoscopy. ID NCT04440865.

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Local triamcinolone injection and selective add-on oral steroids to prevent post-ESD esophageal stricture: retrospective analysis of a prospective protocol in a Western center.

Our protocol led to a low stricture rate even after extensive resection. As a single session treatment without systemic side effects, triamcinolone injection could provide benefits as a preventive method after large esophageal resection.

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Technical failure during Colorectal Endoscopic Full Thickness Resection: The "through thick and thin" Study.

Colorectal EFTR with FTRD is a challenging technique with a not negligible rate of technical failure and complications. Experience in rescue resection techniques and multidisciplinary management are mandatory in this setting.

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Gastroenterology

A Direct Link Implicating Loss of SLC26A6 to Gut Microbial Dysbiosis, Compromised Barrier Integrity and Inflammation.

Our data demonstrate that loss of PAT1 disrupts gut microbiome and related metabolites, decreases gut barrier integrity, and increases host susceptibility to intestinal inflammation. These findings, thus, highlight a novel role of the oxalate transporter PAT1 in promoting gut barrier integrity and its deficiency appears to contribute to the pathogenesis of IBD.

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Resolution of acinar dedifferentiation regulates tissue remodeling in pancreatic injury and cancer initiation.

Our results indicate that our transcriptome analysis can be used to investigate conserved mechanisms of tissue injury. We demonstrate that Sox4 restrains acinar dedifferentiation and is necessary for the specification of acinar-derived metaplastic cells in pancreatic injury and cancer initiation and is activated upon Kras ablation and tumor regression in mice. By uncovering novel potential strategies to promote tissue homeostasis, our findings offer new avenues for preventing the development of PDAC.

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Gastrointest Endosc

Bariatric Endoscopic Antral Myotomy: A Pilot Study Assessing Technical Feasibility, Physiologic Changes, and Preliminary Efficacy.

This pilot study suggests BEAM is feasible and appears to induce delayed gastric emptying that is associated with significant weight loss, without symptoms of gastroparesis.

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ENDOSCOPIC ULTRASOUND-GUIDED RADIOFREQUENCY ABLATION FOR PANCREATIC ADENOCARCINOMA.

In our institutional experience, this treatment protocol appears safe as patients tolerated the combination of chemotherapy and ablation. Patients underwent pancreatic resection with uneventful recovery. This novel neoadjuvant approach may provide a more effective alternative to chemotherapy alone.

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Endoscopic closure of large gastric defects with a novel through-the-scope closing device in a porcine model (with videos).

The novel TTS-BT closure device is feasible and safe for closing large gastric perforations and could be a promising tool for clinical practice.

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Endoscopic treatment of bile duct stones with benign choledochojejunal anastomotic stenosis.

[CONCLUSIONS]: Endoscopic interventions for BDS with bCJS are useful and relatively safe; however, long-term follow-ups showed frequent recurrences. Recurrence was common in patients not treated with the combination of PDCS at BDS removal and those without waist disappearance at the CAS by balloon dilation.

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Predictors for Lymph Node Metastasis and Survival of Patients with T1b Esophageal Adenocarcinoma Treated with Surgery and Endoscopic Therapy: An Analysis of Surveillance, Epidemiology, and End Results Database.

In T1b EAC, tumor size ≥20mm and poor differentiation are notable risk factors for LNM. ET showed comparable CSS outcomes to surgery for carefully selected T1bN0M0 lesions. CRT did not provide additional survival benefit for these lesions; however, large scale studies are required to validate this finding.

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Safety of first surveillance colonoscopy at 12 months after piecemeal endoscopic mucosal resection of large non-pedunculated colorectal lesions.

Twelve-month surveillance appears acceptable for selected colorectal lesions ≥ 20 mm removed by pEMR. A randomized trial comparing initial 6-month to 12-month surveillance is warranted for selected lesions.

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The 2023 top 10 list of endoscopy topics in medical publishing: an annual review by the American Society for Gastrointestinal Endoscopy Editorial Board.

The 10 identified areas collectively represent advances in the following endoscopic spheres: GI bleeding, endohepatology, endoscopic palliation, artificial intelligence and polyp detection, artificial intelligence beyond the colon, better polypectomy and endoscopic mucosal resection, how to make endoscopy units greener, high quality upper endoscopy, endoscopic tissue apposition/closure devices, and endoscopic submucosal dissection. Each board member was assigned a topic area around which summarized relevant important articles, thereby generating this overview of the "top 10" endoscopic advances of 2023.

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Gut

Human milk oligosaccharide 2'-fucosyllactose protects against high-fat diet-induced obesity by changing intestinal mucus production, composition and degradation linked to changes in gut microbiota and faecal proteome profiles in mice.

Our results show that the HMO 2'FL influences host metabolism by modulating the mucus layer, gut microbiota and eCB system and propose the mucus layer as a new potential target for the prevention of obesity and related disorders.

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Landscape of the gut mycobiome dynamics during pregnancy and its relationship with host metabolism and pregnancy health.

This study provides a landscape of gut mycobiome dynamics during pregnancy and its relationship with host metabolism and pregnancy health, which lays the foundation of the future gut mycobiome investigation for healthy pregnancy.

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Novel IL-4/HB-EGF-dependent crosstalk between eosinophils and macrophages controls liver regeneration after ischaemia and reperfusion injury.

Together, these studies uncovered an indispensable role of eosinophils in liver repair after acute injury and identified a novel crosstalk between eosinophils and macrophages through the IL-4/HB-EGF axis.

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Targeting squalene epoxidase restores anti-PD-1 efficacy in metabolic dysfunction-associated steatohepatitis-induced hepatocellular carcinoma.

SQLE induces an impaired antitumour response in MASH-HCC via attenuating CD8 + T cell function and augmenting immunosuppressive MDSCs. SQLE is a promising target in boosting anti-PD-1 immunotherapy for MASH-HCC.

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The Peptidoglycan Recognition Protein 1 confers immune evasive properties on pancreatic cancer stem cells.

Importantly, these findings were not only replicated in human models, but clinically, secreted PGLYRP1 levels were significantly elevated in patients with PDAC. This study establishes PGLYRP1 as a novel CSC-associated marker crucial for immune evasion, particularly against macrophage phagocytosis and T-cell killing, presenting it as a promising target for PDAC immunotherapy.

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Hepatology

"Insights into ALD & AUD diagnosis and prognosis: Exploring AI and multi-modal data streams".

An emphasis is made on how these approaches will also benefit the detection and management of alcohol use disorder (AUD). Our discussion encompasses challenges and limitations, concluding with a glimpse into the promising future of these advancements.

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Epidemiology, screening, and Co-management of type 2 diabetes mellitus and Metabolic-dysfunction associated steatotic liver disease.

The emergence of numerous randomized clinical trials has shed light on the treatment of T2DM combined with MASLD. This review uncovered the epidemiology of the intertwined T2DM and MASLD, offer insights into the evaluation of hepatic fibrosis in T2DM patients, glucose monitoring in MASLD population, and provide comprehensive co-management strategies for addressing both diseases.

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Estimating hepatitis C prevalence in the United States, 2017-2020.

Despite years of an effective cure, estimated prevalence of hepatitis C in 2017-2020 remains unchanged from 2013-2016 when using comparable methodology. When accounting for increased injection drug use, estimated prevalence of hepatitis C is substantially higher than previously reported. National action is urgently needed to expand testing, increase access to treatment, and improve surveillance, especially among medically underserved populations, to support hepatitis C elimination goals.

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Identifying a therapeutic window of opportunity for people living with primary sclerosing cholangitis: Embryology and the overlap of inflammatory bowel disease with immune mediated liver injury.

This is critical for the optimal targeting of studies into PSC etiopathogenesis and emphasizes the concept of a "developmental window of opportunity for therapeutic mitigation" in what is currently recognized as an irreversible disease process. The discovery of such a window would be critically important for the targeting of interventions, both administration of current therapies and therapeutic trial planning.

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MASLD/MetALD and mortality in individuals with any cardio-metabolic risk factor: a population based study with 26.7 years of follow-up.

In individuals with CMRF, the presence of steatotic liver disease (MASLD) alone did not increase the risk of mortality, except in cases with more alcohol consumption (MetALD). Therefore controlling metabolic risk factors and reducing alcohol consumption in people with MASLD or MetALD will be crucial steps to improve long-term health outcomes.

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Targeting cellular cathepsins inhibits hepatitis E virus entry.

In summary, our study highlights the pivotal role of lysosomal cathepsins, especially CTSL, in the HEV entry process. The profound anti-HEV efficacy of the pan-cathepsin inhibitor, K11777, especially with its notable safety profile in primary cells, further underscores its potential as a therapeutic candidate.

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J Hepatol

Bulevirtide monotherapy in patients with chronic HDV: Efficacy and safety results through week 96 from a phase 3 randomized trial.

Virologic and biochemical responses were maintained and/or increased with longer-term BLV therapy, including in those with suboptimal early virologic response. BLV monotherapy for CHD was safe and well tolerated through W96. Impact and implications In July 2023, bulevirtide was fully approved for the treatment of chronic hepatitis delta (CHD) in Europe based on clinical study results from up to 48 weeks of treatment. Understanding the efficacy and safety of bulevirtide over the longer term is important for healthcare providers. In this analysis, we demonstrate that bulevirtide monotherapy for 96 weeks in patients with CHD was associated with continued improvements in combined, virologic, and biochemical responses as well as liver stiffness from week 48 at both the 2-mg and 10-mg doses. Patients with suboptimal virologic responses to bulevirtide at week 24 also benefited from continued therapy, with the majority achieving virologic response or biochemical improvement by week 96. Clinical trials Gov identifier NCT03852719.

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Reviews&Editorials

Plenty of the editorials are available as full text through the publisher website using the provided link

Aliment Pharmacol Ther

AP&T: Editors' declarations of interest.

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Clin Gastroenterol Hepatol

Crafting a Therapeutic Pyramid for Eosinophilic Esophagitis in the Age of Biologics.

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Editorial: Looking into the future of drug development for chronic upper gastrointestinal symptoms and related diseases.

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Gastroenterology

In Memoriam: Peter R. Holt, MD.

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The Progression of Microbiome Therapeutics for the Management of Gastrointestinal Diseases and Beyond.

The field however continues to evolve with a movement towards precision microbiome therapeutics individualizing care for various disorders. This review will describe the use of FMT, microbiota restoration and precision microbiome therapeutics focusing in gastrointestinal and hepatic diseases.

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J Hepatol

Improving HCC Surveillance with abbreviated MRI: A Call to Integrate and Innovate?

The use of ultrasound has been challenged by several metanalyses (4,5) or prospective follow-up studies reporting on a poor sensitivity for the detection of very early-stage HCC. Several factors have been proposed to explain this suboptimal performance, including the difficult liver visualization in obese and/or MASLD patients, a nodular appearance in a subset of cirrhotic livers, the skills and expertise of the operators, and poor adherence to surveillance programs.

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Miscellaneous

misc publications eg case reports, tools of the trade, images of the month, etc…

Am J Gastroenterol

Acceptability of Nonendoscopic Barrett Esophagus Screening in the Population: Some Initial Promising Answers.

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Clin Gastroenterol Hepatol

Chronic hepatitis C related steatotic liver disease is more than "miscellaneous steatotic liver disease".

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Giant Hepatic Hemangioma.

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Is a simplified, less restrictive low FODMAP diet possible? Results from a double-blind, pilot randomized controlled trial.

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Endoscopy

Beyond the scope: diverticular disease and post-colonoscopy colorectal cancer.

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Endoscopy-related musculoskeletal injuries to endoscopists: time for an "ergonomic time-out".

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Gastroenterology

A Case of Hepatobiliary Challenges: Unraveling the Mystery of Bile Duct Disappearance.

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Celiac Disease Moves Into the Current Era of Modern Medicine.

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Sir William Osler, the Two Cultures, and the Learned Profession.

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What Will Technology Do to Gastroenterology?

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Why Gastroenterologists Should Be More Interested in Death.

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Gastrointest Endosc

Top tips for endoscopic ultrasound-guided pelvic abscess drainage.

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Gut

Diagnostic dilemma: sudden onset of multiple skin lesions in a patient with intestinal disease.

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Eosinophils: a novel therapeutic target to promote liver regeneration in acute liver injury?

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Hepatology

Letter to the Editor: Chronic hepatitis B baseline viral load and on-treatment liver cancer risk: A multinational cohort study of HBeAg-Positive patients.

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The obstacle is the way: Finding a path to hepatitis C elimination.

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Letters&Replies

Letters to the editors and authors’ replies

Aliment Pharmacol Ther

Letter: Intestinal permeability accounting for ongoing gastrointestinal symptoms following endoscopic remission in IBD-Authors' reply.

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Letter: Intestinal permeability accounting for ongoing gastrointestinal symptoms following endoscopic remission in IBD.

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Clin Gastroenterol Hepatol

Authors' Reply: Sex differences and immunoglobulin E should not be forgotten in type 1 autoimmune pancreatitis.

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Can endoscopic ultrasound-guided ablation prolong disease-specific survival in pancreatic cysts?

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Guarding the Gate: The Sentinel Role of Endosonograpy in Precluding Unwarranted ERCP.

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Post-Infectious Disorders of Gut-Brain Interaction: A brainstorming story.

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Re-evaluating the proposed association between vonoprazan and gastric cancer following eradication of H. pylori infection.

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Real-World Ammonia Testing in Hepatic Encephalopathy: Spreading Confusion From Patients to Clinicians Without Adding Value.

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Targeting durable remission of fatigue in inflammatory bowel disease.

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Ultra-Processed Food Consumption and Irritable Bowel Syndrome.

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Gut

Beyond traditional subtyping: a multilayered genomic perspective on colorectal cancer.

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Intron-mediated enhancement of SPINK1 expression for pancreatitis therapy.

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J Hepatol

Can we really advise a patient undergoing TIPS that the onset of episodic hepatic encephalopathy will not influence his/her survival?

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Cirrhosis Decompensation: Clinical and Prognostic Analysis from a New Perspective.

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Evidence and Choice: The BCLC Vision for Tailoring Clinical Decision-Making.

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Healthy volunteer bias for the role of genetic risk in dietary effects on hepatic steatosis, inflammation and fibrosis.

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Hepatitis B Virus spliced 1 RNA, a key factor for viral expression.

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Need for risk stratification in treatment of patients with autoimmune hepatitis.

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Sex-Specific Associations of Steatotic Liver Disease with Vascular Health.

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